Mrs. Maloney (for
herself, Mr. Nadler of New York,
Mr. King of New York,
Mr. McMahon,
Mr. Rangel,
Mr. Ackerman,
Mr. Arcuri,
Mr. Bishop of New York,
Mr. Burgess,
Mr. Crowley,
Mr. Engel,
Mr. Hall of New York,
Mr. Higgins,
Mr. Himes,
Mr. Hinchey,
Mr. Israel,
Mr. Lee of New York,
Mrs. Lowey,
Mr. Maffei,
Mr. Massa,
Mrs. McCarthy of New York,
Mr. McGovern,
Mr. McHugh,
Mr. Meeks of New York,
Mr. Pascrell,
Mr. Serrano,
Ms. Sutton,
Mr. Tonko,
Mr. Towns,
Mr. Weiner,
Ms. Woolsey, and
Ms. Clarke) introduced the following
bill; which was referred to the Committee
on Energy and Commerce, and in addition to the Committee on
the Judiciary, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned

A BILL

To amend the Public Health Service Act to extend and
improve protections and services to individuals directly impacted by the
terrorist attack in New York City on September 11, 2001, and for other
purposes.

1.

Short title; table of
contents

(a)

Short
title

This Act may be cited
as the James Zadroga 9/11 Health and
Compensation Act of 2009.

(b)

Table of
Contents

The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Findings.

Title I—World Trade Center Health Program

Sec. 101. World Trade Center Health
Program.

Title XXX—World Trade Center Health Program

Subtitle A—Establishment of Program; Advisory and Steering
Committees

Sec. 3001. Establishment of World Trade Center Health Program
within NIOSH.

Sec. 3022. Followup monitoring and treatment of certified
eligible WTC community members for WTC-related health conditions.

Sec. 3023. Followup monitoring and treatment of other
individuals with WTC-related health conditions.

Part 3—National Arrangement for Benefits for Eligible Individuals
Outside New York

Sec. 3031. National arrangement for benefits for eligible
individuals outside New York.

Subtitle C—Research into Conditions

Sec. 3041. Research regarding certain health conditions related
to September 11 terrorist attacks in New York City.

Subtitle D—Programs of the New York City Department of Health
and Mental Hygiene

Sec. 3051. World Trade Center Health Registry.

Sec. 3052. Mental health
services.

Title II—September 11th Victim Compensation Fund of
2001

Sec. 201. Definitions.

Sec. 202. Extended and expanded eligibility for
compensation.

Sec. 203. Requirement to update regulations.

Sec. 204. Limited liability for certain claims.

2.

Findings

Congress finds the following:

(1)

Thousands of rescue
workers who responded to the areas devastated by the terrorist attacks of
September 11, local residents, office and area workers, and school children
continue to suffer significant medical problems as a result of compromised air
quality and the release of other toxins from the attack sites.

(2)

In a September 2006 peer-reviewed study
conducted by the World Trade Center Medical Monitoring Program, of 9,500 World
Trade Center responders, almost 70 percent of World Trade Center responders had
a new or worsened respiratory symptom that developed during or after their time
working at the World Trade Center; among the responders who were asymptomatic
before 9/11, 61 percent developed respiratory symptoms while working at the
World Trade Center; close to 60 percent still had a new or worsened respiratory
symptom at the time of their examination; one-third had abnormal pulmonary
function tests; and severe respiratory conditions including pneumonia were
significantly more common in the 6 months after 9/11 than in the prior 6
months.

(3)

An April 2006
study documented that, on average, a New York City firefighter who responded to
the World Trade Center has experienced a loss of 12 years of lung
capacity.

(4)

A peer-reviewed study of residents who
lived near the World Trade Center titled “The World Trade Center Residents’
Respiratory Health Study: New Onset Respiratory Symptoms and Pulmonary
Function”, found that data demonstrated a three-fold increase in new-onset,
persistent lower respiratory symptoms in residents near the former World Trade
Center as compared to a control population.

(5)

Previous research
on the health impacts of the devastation caused by the September 11 terrorist
attacks has shown relationships between the air quality from Ground Zero and a
host of health impacts, including lower pregnancy rates, higher rates of
respiratory and lung disorders, and a variety of post-disaster mental health
conditions (including posttraumatic stress disorder) in workers and residents
near Ground Zero.

(6)

A variety of tests conducted by independent
scientists have concluded that significant WTC contamination settled in indoor
environments surrounding the disaster site. The Environmental Protection
Agency’s (EPA) cleanup programs for indoor residential spaces, in 2003 and
2005, though limited, are an acknowledgment that indoor contamination continued
after the WTC attacks.

(7)

At the request of the Department of Energy,
the Davis DELTA Group at the University of California conducted outdoor dust
sampling in October 2001 at Varick and Houston Streets (approximately 1.2 miles
north of Ground Zero) and found that the contamination from the World Trade
Center outdid even the worst pollution from the Kuwait oil fields
fires. Further, the United States Geological Survey (USGS) reported on
November 27, 2001, that dust samples collected from indoor surfaces registered
at levels that were as caustic as liquid drain cleaners.

(8)

According to both the EPA’s own Inspector
General’s (EPA IG) report of August 21, 2003 and General Accountability
Offices’s (GAO) report of September 2007, no comprehensive program has ever
been conducted in order to characterize the full extent of WTC contamination,
and therefore the full impact of that contamination—geographic or
otherwise—remains unknown.

(9)

Such reports found that there has never
been a comprehensive program to remediate WTC toxins from indoor spaces. Thus,
area residents, workers and students may continue to be exposed to WTC
contamination in their homes, workplaces and schools.

(10)

Because of the failure to release federally
appropriated funds for community care, a lack of sufficient outreach, the fact
that many community members are receiving care from physicians outside the
current City-funded World Trade Center Environmental Health Center program and
thus fall outside data collection efforts, and other factors, the number of
community members being treated at the World Trade Center Environmental Health
Center underrepresents the total number in the community that have been
affected by exposure to Ground Zero toxins.

(11)

Research by
Columbia University’s Center for Children’s Environmental Health has shown
negative health effects on babies born to women living within 2 miles of the
World Trade Center in the month following 9/11.

(12)

Federal funding
allocated for the monitoring of rescue workers’ health is not sufficient to
ensure the long-term study of health impacts of September 11.

(13)

A significant portion of those who have
developed health problems as result of exposures to airborne toxins or other
hazards resulting from the September 11, 2001, attacks on the World Trade
Center have no health insurance, have lost their health insurance as a result
of the attacks, or have inadequate health insurance.

(14)

The Federal program to provide medical
treatments to those who responded to the September 11 aftermath, and who
continue to experience health problems as a result, was finally established
more than five years after the attacks, but has no certain long-term
funding.

(15)

Rescue workers
and volunteers seeking workers’ compensation have reported that their
applications have been denied, delayed for months, or redirected, instead of
receiving assistance in a timely and supportive manner.

(16)

A February 2007 report released by the City
of New York estimated that approximately 410,000 people were the most heavily
exposed to the environmental hazards and trauma of the September 11 terrorist
attacks. More than 30 percent of the Fire Department of the City of New York
first responders were still experiencing some respiratory symptoms more than
five years after the attacks and according to the report, 59 percent of those
seen by the WTC Environmental Health Center at Bellevue Hospital (which serves
community members) are without insurance and 65 percent have incomes less than
$15,000 per year. The report also found a need to continue and expand mental
health services.

(17)

Since the 5th anniversary of the attack
(September 11, 2006), hundreds of workers a month have been signing up with the
monitoring and treatment programs.

(18)

In April 2008, the Department of Health and
Human Services reported to Congress that in fiscal year 2007 11,359 patients
received medical treatment in the existing WTC Responder Medical and Treatment
program for WTC-related health problems, and that number of responders who need
treatment and the severity of health problems is expected to increase.

(19)

The September 11
Victim Compensation Fund of 2001 was established to provide compensation to
individuals who were physically injured or killed as a result of the
terrorist-related aircraft crashes of September 11, 2001.

(20)

The deadline for
filing claims for compensation under the Victim Compensation Fund was December
22, 2003.

(21)

Some individuals
did not know they were eligible to file claims for compensation for injuries or
did not know they had suffered physical harm as a result of the
terrorist-related aircraft crashes until after the December 22, 2003,
deadline.

(22)

Further research
is needed to evaluate more comprehensively the extent of the health impacts of
September 11, including research for emerging health problems such as cancer,
which have been predicted.

(23)

Research is
needed regarding possible treatment for the illnesses and injuries of September
11.

(24)

The Federal
response to medical and financial issues arising from the September 11 response
efforts needs a comprehensive, coordinated long-term response in order to meet
the needs of all the individuals who were exposed to the toxins of Ground Zero
and are suffering health problems from the disaster.

(25)

The failure to extend the appointment of
Dr. John Howard as Director of the National Institute for Occupational Safety
and Health in July 2008 is not in the interests of the administration of such
Institute nor the continued operation of the World Trade Center Medical
Monitoring and Treatment Program which he has headed, and the Secretary of
Health and Human Services should reconsider extending such appointment.

I

World
Trade Center Health Program

101.

World Trade
Center Health Program

The
Public Health Service Act is amended
by adding at the end the following new title:

XXX

World Trade
Center Health Program

A

Establishment of
Program; Advisory and Steering Committees

3001.

Establishment
of World Trade Center Health Program within NIOSH

(a)

In
general

There is hereby established within the National Institute
for Occupational Safety and Health a program to be known as the World
Trade Center Health Program (in this title referred to as the
WTC program) to provide—

(1)

medical monitoring and treatment benefits
to eligible emergency responders and recovery and clean-up workers (including
those who are Federal employees) who responded to the September 11, 2001,
terrorist attacks on the World Trade Center; and

(2)

initial health
evaluation, monitoring, and treatment benefits to residents and other building
occupants and area workers in New York City who were directly impacted and
adversely affected by such attacks.

(b)

Components of
Program

The WTC program includes the following components:

(1)

Medical
monitoring for responders

Medical monitoring under section 3011,
including clinical examinations and long-term health monitoring and analysis
for individuals who were likely to have been exposed to airborne toxins that
were released, or to other hazards, as a result of the September 11, 2001,
terrorist attacks on the World Trade Center.

(2)

Initial health
evaluation for community members

An initial health evaluation under section
3021, including an evaluation to determine eligibility for followup monitoring
and treatment.

(3)

Follow-up
monitoring and treatment for wtc-related conditions for responders and
community members

Provision under sections 3012, 3022, and 3023
of follow-up monitoring and treatment and payment, subject to the provisions of
subsection (d), for all medically necessary health and mental health care
expenses (including necessary prescription drugs) of individuals with a
WTC-related health condition.

(4)

Outreach

Establishment under section 3004 of an
outreach program to potentially eligible individuals concerning the benefits
under this title.

(5)

Uniform data
collection

Collection under section 3005 of health and mental
health data on individuals receiving monitoring or treatment benefits, using a
uniform system of data collection.

(6)

Research on wtc
conditions

Establishment under subtitle C of a research program
on health conditions resulting from the September 11, 2001, terrorist attacks
on the World Trade Center.

(c)

No
cost-sharing

Monitoring and
treatment benefits and initial health evaluation benefits are provided under
subtitle B without any deductibles, copayments, or other cost-sharing to an
eligible WTC responder or any eligible WTC community member.

(d)

Payor

(1)

In
general

Except as provided in paragraphs (2) and (3), the cost of
monitoring and treatment benefits and initial health evaluation benefits
provided under subtitle B shall be paid for by the WTC program.

(2)

Workers’
compensation payment

(A)

In
general

Except as provided in subparagraph (B), payment for
treatment under subtitle B of a WTC-related condition in an individual that is
work-related shall be reduced or recouped to the extent that the Secretary
determines that payment has been made, or can reasonably be expected to be
made, under a workers’ compensation law or plan of the United States or a
State, or other work-related injury or illness benefit plan of the employer of
such individual, for such treatment. The provisions of clauses (iii), (iv),
(v), and (vi) of paragraph (2)(B) of section 1862(b) of the Social Security Act
(42 U.S.C. 1395y(b)(2)) and paragraph (3) of such section shall apply to the
recoupment under this paragraph of a payment to the WTC program with respect to
a workers’ compensation law or plan, or other work-related injury or illness
plan of the employer involved, and such individual in the same manner as such
provisions apply to the reimbursement of a payment under section 1862(b)(2) of
such Act to the Secretary, with respect to such a law or plan and an individual
entitled to benefits under title XVIII of such Act.

(B)

Exception

If the WTC Program Administrator certifies
that the City of New York has contributed the matching contribution required
under section 3006(a)(3) for a 12-month period (specified by the WTC Program
Administrator), subparagraph (A) shall not apply for that 12-month period with
respect to a workers’ compensation law or plan, including line of duty
compensation, to which the City is obligated to make payments.

(3)

Health insurance
coverage

(A)

In
general

In the case of an individual who has a WTC-related
condition that is not work-related and has health coverage for such condition
through any public or private health plan, the provisions of section 1862(b) of
the Social Security Act (42 U.S.C. 1395y(b)) shall apply to such a health plan
and such individual in the same manner as they apply to a group health plan and
an individual entitled to benefits under title XVIII of such Act pursuant to
section 226(a). Any costs for items and services covered under such plan that
are not reimbursed by such health plan, due to the application of deductibles,
copayments, coinsurance, other cost-sharing, or otherwise, are reimbursable
under this title to the extent that they are covered under the WTC
program.

(B)

Recovery by
individual providers

Nothing in subparagraph (A) shall be
construed as requiring an entity providing monitoring and treatment under this
title to seek reimbursement under a health plan with which the entity has no
contract for reimbursement.

(4)

Work-related
described

For the purposes of
this subsection, a WTC-related condition shall be treated as a condition that
is work-related if—

(A)

the condition is diagnosed in an eligible
WTC responder, or in an individual who qualifies as an eligible WTC community
member on the basis of being a rescue, recovery, or clean-up worker; or

(B)

with respect to the condition the
individual has filed and had established a claim under a workers' compensation
law or plan of the United States or a State, or other work-related injury or
illness benefit plan of the employer of such individual.

(e)

Quality
assurance and monitoring of clinical expenditures

(1)

Quality
assurance

The WTC Program
Administrator working with the Clinical Centers of Excellence shall develop and
implement a quality assurance program for the medical monitoring and treatment
delivered by such Centers of Excellence and any other participating health care
providers. Such program shall include—

(A)

adherence to
medical monitoring and treatment protocols;

(B)

appropriate
diagnostic and treatment referrals for participants;

(C)

prompt
communication of test results to participants; and

(D)

such other elements
as the Administrator specifies in consultation with the Clinical Centers of
Excellence.

(2)

Fraud
prevention

The WTC Program Administrator shall develop and
implement a program to review the program’s health care expenditures to detect
fraudulent or duplicate billing and payment for inappropriate services. Such
program shall be similar to current methods used in connection with the
Medicare program under title XVIII of the Social Security Act. This title is a
Federal health care program (as defined in section 1128B(f) of such Act) and is
a health plan (as defined in section 1128C(c) of such Act) for purposes of
applying sections 1128 through 1128E of such Act.

(f)

WTC Program
Administration

The WTC
program shall be administered by the Director of the National Institute for
Occupational Safety and Health, or a designee of such Director.

(g)

Annual program
report

(1)

In
general

Not later than 6
months after the end of each fiscal year in which the WTC program is in
operation, the WTC Program Administrator shall submit an annual report to the
Congress on the operations of this title for such fiscal year and for the
entire period of operation of the program.

(2)

Contents of
report

Each annual report
under paragraph (1) shall include the following:

(A)

Eligible
individuals

Information for
each clinical program described in paragraph (3)—

(i)

on the number of individuals who applied
for certification under subtitle B and the number of such individuals who were
so certified;

(ii)

of
the individuals who were certified, on the number who received medical
monitoring under the program and the number of such individuals who received
medical treatment under the program;

(iii)

with respect to
individuals so certified who received such treatment, on the WTC-related health
conditions for which they were treated; and

(iv)

on the projected number of individuals who
will be certified under subtitle B in the succeeding fiscal year.

(B)

Monitoring,
initial health evaluation, and treatment costs

For each clinical
program so described—

(i)

information on the
costs of monitoring and initial health evaluation and the costs of treatment
and on the estimated costs of such monitoring, evaluation, and treatment in the
succeeding fiscal year; and

(ii)

an estimate of
the cost of medical treatment for WTC-related conditions that have been paid
for or reimbursed by workers’ compensation, by public or private health plans,
or by the City of New York under section 3012(c)(4).

(C)

Administrative
costs

Information on the cost of administering the program,
including costs of program support, data collection and analysis, and research
conducted under the program.

(D)

Administrative
experience

Information on the administrative performance of the
program, including—

(i)

the performance of
the program in providing timely evaluation of and treatment to eligible
individuals; and

(ii)

a
list of the Clinical Centers of Excellence and other providers that are
participating in the program.

(E)

Scientific
reports

A summary of the
findings of any new scientific reports or studies on the health effects
associated with WTC center exposures, including the findings of research
conducted under section 3041(a).

(F)

Advisory
committee recommendations

A list of recommendations by the WTC
Scientific/Technical Advisory Committee on additional WTC program eligibility
criteria and on additional WTC-related health conditions and the action of the
WTC Program Administrator concerning each such recommendation.

(3)

Separate
clinical programs described

In paragraph (2), each of the
following shall be treated as a separate clinical program of the WTC
program:

(A)

FDNY
responders

The benefits provided for eligible WTC responders
described in section 3006(b)(1)(A).

(B)

Other eligible
WTC responders

The benefits
provided for eligible WTC responders not described in subparagraph (A).

(C)

Eligible WTC
community members

The
benefits provided for eligible WTC community members in section
3006(b)(1)(C).

when the number of
certifications for eligible WTC responders subject to the limit established
under section 3011(a)(5) has reached 80 percent of such limit; and

(2)

when the number of certifications for
eligible WTC community members subject to the limit established under section
3021(a)(5) has reached 80 percent of such limit.

(i)

GAO
report

Not later than 3 years
after the date of the enactment of this Act, the Comptroller General of the
United States shall submit to the Congress a report on the costs of the
monitoring and treatment programs provided under this title.

(j)

NYC
recommendations

The City of
New York may make recommendations to the WTC Program Administrator on ways to
improve the monitoring and treatment programs under this title for both
eligible WTC responders and eligible WTC community members.

3002.

WTC Health
Program Scientific/Technical Advisory Committee

(a)

Establishment

The WTC Program Administrator shall
establish an advisory committee to be known as the WTC Health Program
Scientific/Technical Advisory Committee (in this section referred to as the
Advisory Committee) to review scientific and medical evidence
and to make recommendations to the Administrator on additional WTC program
eligibility criteria and on additional WTC-related health conditions.

(b)

Composition

The WTC Program Administrator shall appoint
the members of the Advisory Committee and shall include at least—

(1)

4 occupational
physicians, at least two of whom have experience treating WTC rescue and
recovery workers;

(2)

1 physician with expertise in pulmonary
medicine;

(3)

2 environmental medicine or environmental
health specialists;

(4)

2 representatives of eligible WTC
responders;

(5)

2 representatives of WTC community
members;

(6)

an industrial
hygienist;

(7)

a
toxicologist;

(8)

an epidemiologist;
and

(9)

a mental health
professional.

(c)

Meetings

The
Advisory Committee shall meet at such frequency as may be required to carry out
its duties.

(d)

Reports

The
WTC Program Administrator shall provide for publication of recommendations of
the Advisory Committee on the public website established for the WTC
program.

(e)

Authorization of
appropriations

For the purpose of carrying out this section,
there are authorized to be appropriated such sums as may be necessary, not to
exceed $100,000, for each fiscal year beginning with fiscal year 2009.

(f)

Duration

Notwithstanding
any other provision of law, the Advisory Committee shall continue in operation
during the period in which the WTC program is in operation.

The
WTC Program Administrator shall establish two steering committees (each in this
section referred to as a Steering Committee) as follows:

(1)

WTC responders
steering committee

One
steering committee, to be known as the WTC Responders Steering Committee, for
the purpose of facilitating the coordination of medical monitoring and
treatment programs for the eligible WTC responders under part 1 of subtitle
B.

(2)

WTC community
program steering committee

One steering committee, to be known as the
WTC Community Program Steering Committee, for the purpose of facilitating the
coordination of initial health evaluations, monitoring, and treatment programs
for eligible WTC community members under part 2 of subtitle B.

(b)

Membership

(1)

Initial
membership of WTC Responders Steering Committee

The WTC Responders Steering Committee shall
initially be composed of members of the WTC Monitoring and Treatment Program
Steering Committee (as in existence on the day before the date of the enactment
of this title). In addition, the committee membership shall include—

(A)

a representative of the Police Commissioner
of the City of New York;

(B)

a representative of the Department of
Health of the City of New York;

(C)

a representative
of another agency of the City of New York, selected by the Mayor of New York
City, which had a large number of non-uniformed City workers who responded to
the WTC disaster; and

(D)

three
representatives of eligible WTC responders;

in order
that eligible WTC responders constitute half the members of the Steering
Committee.(2)

Initial
membership of WTC Community Program Steering Committee

(A)

In
general

The WTC Community
Program Steering Committee shall initially be composed of members of the WTC
Environmental Health Center Community Advisory Committee (as in existence on
the day before the date of the enactment of this title) and shall initially
have, as voting members, the following:

(i)

11 representatives of the affected
populations of residents, students, area workers, and other community
members.

Five specialists with WTC related expertise
or experience in treating non-responder WTC diseases, such as a pediatrician,
an epidemiologist, a psychiatrist or psychologist, an
environmental/occupational specialists or a social worker from a WTC
Environmental Health Center treatment site, or other relevant
specialists.

(vi)

A representative of the Department of
Health and Mental Hygiene of the City of New York.

(B)

Appointments

(i)

WTC EHC
Community Advisory Committee

The WTC Environmental Health Center
Community Advisory Committee as in existence on the date of the enactment of
this title shall nominate members for positions described in subparagraph
(A)(i).

(ii)

NYC Health and
Hospitals Corporation

The New York City Health and Hospitals
Corporation shall nominate members for positions described in clauses (iv) and
(v) of subparagraph (A).

(iii)

Timing

Nominations
under clauses (i) and (ii) shall be recommended to the WTC Program
Administrator not later than 60 days after the date of the enactment of this
title.

(iv)

Appointment

The
WTC Program Administrator shall appoint members of the WTC Community Program
Steering Committee not later than 90 days after the date of the enactment of
this title.

(v)

General
representatives

Of the members appointed under subparagraph
(A)(i)—

(I)

the representation
shall reflect the broad and diverse WTC-affected populations and constituencies
and the diversity of impacted neighborhoods, including residents, hard-to-reach
populations, students, area workers, school parents, community-based
organizations, Community Boards, WTC Environmental Health Center patients,
labor unions, and labor advocacy organizations; and

(II)

no one individual
organization can have more than one representative.

(3)

Additional
appointments

Each Steering
Committee may appoint, if approved by a majority of voting members of the
Committee, additional members to the Committee.

(4)

Vacancies

A
vacancy in a Steering Committee shall be filled by the Steering Committee,
subject to the approval of the WTC Program Administrator, so long as—

(A)

in the case of the
WTC Responders Steering Committee, the composition of the Committee includes
representatives of eligible WTC responders and representatives of each Clinical
Center of Excellence and each Coordinating Center of Excellence that serves
eligible WTC responders and such composition has eligible WTC responders
constituting half of the membership of the Steering Committee; or

(B)

in the case of the WTC Community Program
Steering Committee, the composition of the Committee includes representatives
of eligible WTC community members and representatives of each Clinical Center
of Excellence and each Coordinating Center of Excellence that serves eligible
WTC community members and the nominating process is consistent with paragraph
(2)(B).

(5)

Co-Chairs of WTC
Community Program Steering Committee

The WTC Community Program Steering
Committee shall have two Co-Chairs as follows:

(A)

Community/Labor
Co-Chair

A Community/Labor Co-Chair who shall be chosen by the
community and labor-based members of the Steering Committee.

(B)

Environmental
Health Clinic Co-Chair

A WTC Environmental Health Clinic Co-Chair
who shall be chosen by the WTC Environmental Health Center members on the
Steering Committee.

(c)

Relation to
FACA

Each Steering Committee
shall not be subject to the Federal Advisory Committee Act.

(d)

Meetings

Each Steering Committee shall meet at such
frequency necessary to carry out its duties, but not less than 4 times each
calendar year and at least two such meetings each year shall be a joint meeting
with the voting membership of the other Steering Committee for the purpose of
exchanging information regarding the WTC program.

(e)

Duration

Notwithstanding
any other provision of law, each Steering Committee shall continue in operation
during the period in which the WTC program is in operation.

3004.

Community
education and outreach

(a)

In
general

The WTC Program
Administrator shall institute a program that provides education and outreach on
the existence and availability of services under the WTC program. The outreach
and education program—

(1)

shall include—

(A)

the establishment
of a public website with information about the WTC program;

(B)

meetings with
potentially eligible populations;

(C)

development and
dissemination of outreach materials informing people about the program;
and

(D)

the establishment
of phone information services; and

(2)

shall be conducted
in a manner intended—

(A)

to reach all
affected populations; and

(B)

to include
materials for culturally and linguistically diverse populations.

(b)

Partnerships

To the greatest extent possible, in
carrying out this section, the WTC Program Administrator shall enter into
partnerships with local governments and organizations with experience
performing outreach to the affected populations, including community and
labor-based organizations.

3005.

Uniform data
collection

(a)

In
general

The WTC Program
Administrator shall provide for the uniform collection of data (and analysis of
data and regular reports to the Administrator) on the utilization of monitoring
and treatment benefits provided to eligible WTC responders and eligible WTC
community members, the prevalence of WTC-related health conditions, and the
identification of new WTC-related medical conditions. Such data shall be
collected for all individuals provided monitoring or treatment benefits under
subtitle B and regardless of their place of residence or Clinical Center of
Excellence through which the benefits are provided.

(b)

Coordinating
through Centers of Excellence

Each Clinical Center of Excellence
shall collect data described in subsection (a) and report such data to the
corresponding Coordinating Center of Excellence for analysis by such
Coordinating Center of Excellence.

(c)

Privacy

The data collection and analysis under this
section shall be conducted in a manner that protects the confidentiality of
individually identifiable health information consistent with applicable legal
requirements.

3006.

Centers of
excellence

(a)

In
general

(1)

Contracts with
clinical centers of excellence

The WTC Program Administrator shall enter
into contracts with Clinical Centers of Excellence specified in subsection
(b)(1)—

(A)

for the provision
of monitoring and treatment benefits and initial health evaluation benefits
under subtitle B;

(B)

for the provision of outreach activities to
individuals eligible for such monitoring and treatment benefits, for initial
health evaluation benefits, and for follow-up to individuals who are enrolled
in the monitoring program;

(C)

for the provision
of counseling for benefits under subtitle B, with respect to WTC-related health
conditions, for individuals eligible for such benefits;

(D)

for the provision of counseling for
benefits for WTC-related health conditions that may be available under Workers’
Compensation or other benefit programs for work-related injuries or illnesses,
health insurance, disability insurance, or other insurance plans or through
public or private social service agencies and assisting eligible individuals in
applying for such benefits;

(E)

for the provision of translational and
interpretive services as for program participants who are not English language
proficient; and

(F)

for the collection
and reporting of data in accordance with section 3005.

(2)

Contracts with
coordinating centers of excellence

The WTC Program Administrator shall enter
into contracts with Coordinating Centers of Excellence specified in subsection
(b)(2)—

(A)

for receiving,
analyzing, and reporting to the WTC Program Administrator on data, in
accordance with section 3005, that has been collected and reported to such
Coordinating Centers by the corresponding Clinical Centers of Excellence under
subsection (d)(3);

(B)

for the
development of medical monitoring, initial health evaluation, and treatment
protocols, with respect to WTC-related health conditions;

(C)

for coordinating
the outreach activities conducted under paragraph (1)(B) by each corresponding
Clinical Center of Excellence;

(D)

for establishing
criteria for the credentialing of medical providers participating in the
nationwide network under section 3031;

(E)

for coordinating and administrating the
activities of the WTC Health Program Steering Committees established under
section 3003(a); and

(F)

for meeting periodically with the
corresponding Clinical Centers of Excellence to obtain input on the analysis
and reporting of data collected under subparagraph (A) and on the development
of medical monitoring, initial health evaluation, and treatment protocols under
subparagraph (B).

The
medical providers under subparagraph (D) shall be selected by the WTC Program
Administrator on the basis of their experience treating or diagnosing the
medical conditions included in the list of identified WTC-related conditions
for responders and of identified WTC-related conditions for community
members.(3)

Required
participation by New York City in monitoring and treatment program and
costs

(A)

In
general

In order for New York
City, any agency or Department thereof, or the New York City Health and
Hospitals Corporation to qualify for a contract for the provision of monitoring
and treatment benefits and other services under section 3006, New York City is
required to contribute a matching amount of 10 percent of the amount of the
covered monitoring and treatment payment (as defined in subparagraph
(B)).

(B)

Covered
monitoring and treatment payment defined

For the purposes of this
paragraph, the term covered monitoring and treatment payment
means payment under paragraphs (1) and (2), including under such paragraph as
applied under section 3021(b), 3022(a), and 3023, and reimbursement under
3006(c) for items and services furnished by a Clinical Center of Excellence or
Coordinating Center of Excellence, and providers designated by the WTC Program
under section 3031, after the application of paragraphs (2) and (3) of section
3001 (d).

(C)

Payment of New
York City share of monitoring and treatment costs

The WTC Program
Administrator shall—

(i)

bill the amount
specified in subparagraph (A) directly to New York City; and

(ii)

certify
periodically, for purposes of section 3001(d)(2), whether or not New York City
has paid the amount so billed.

(D)

Limitation on
required amount

In no case is New York City required under this
paragraph to contribute more than a total of $500,000,000 over any 10-year
period.

(b)

Centers of
Excellence Defined

(1)

Clinical center
of excellence

In this title, the term Clinical Center of
Excellence means the following:

(A)

For fdny
responders

With respect to an eligible WTC responder who
responded to the 9/11 attacks as an employee of the Fire Department of the City
of New York and who—

(i)

is
an active employee of such Department—

(I)

with respect to
monitoring, such Fire Department; and

(II)

with respect to
treatment, such Fire Department (or such entity as has entered into a contract
with the Fire Department for treatment of such responders) or any other
Clinical Center of Excellence described in subparagraph (B), (C), or (D);
or

(ii)

is not an active employee of such
Department, such Fire Department (or such entity as has entered into a contract
with the Fire Department for monitoring or treatment of such responders) or any
other or any other Clinical Center of Excellence described in subparagraph (B),
(C), or (D).

(B)

Other eligible
WTC responders

With respect to other eligible WTC responders,
whether or not they reside in the New York Metropolitan area, the Mt. Sinai
coordinated consortium, Queens College, State University of New York at Stony
Brook, University of Medicine and Dentistry of New Jersey, and Bellevue
Hospital.

(C)

WTC community
members

With respect to
eligible WTC community members, whether or not they reside in the New York
Metropolitan area, the World Trade Center Environmental Health Center at
Bellevue Hospital and such hospitals or other facilities, including but not
limited to those within the New York City Health and Hospitals Corporation, as
are identified by the WTC Program Administrator.

(D)

All eligible WTC
responders and eligible WTC community members

With respect to all eligible WTC responders
and eligible WTC community members, such other hospitals or other facilities as
are identified by the WTC Program Administrator.

The WTC
Program Administrator shall limit the number of additional Centers of
Excellence identified under subparagraph (D) to ensure that the participating
centers have adequate experience in the treatment and diagnosis of identified
WTC-related medical conditions.(2)

Coordinating
center of excellence

In this title, the term Coordinating
Center of Excellence means the following:

(A)

For fdny
responders

With respect to an eligible WTC responder who
responded to the 9/11 attacks as an employee of the Fire Department of the City
of New York, such Fire Department.

(B)

Other wtc
responders

With respect to other eligible WTC responders, the Mt.
Sinai coordinated consortium.

(C)

Wtc community
members

With respect to
eligible WTC community members, the World Trade Center Environmental Health
Center at Bellevue Hospital.

(3)

Corresponding
centers

In this title, a Clinical Center of Excellence and a
Coordinating Center of Excellence shall be treated as
corresponding to the extent that such Clinical Center and
Coordinating Center serve the same population group.

(c)

Reimbursement
for non-treatment, non-monitoring program costs

A Clinical or
Coordinating Center of Excellence with a contract under this section shall be
reimbursed for the costs of such Center in carrying out the activities
described in subsection (a), other than those described in subsection
(a)(1)(A), subject to the provisions of section 3001(d), as follows:

(1)

Clinical centers
of excellence

For carrying
out subparagraphs (B) through (F) of subsection (a)(1)—

(A)

Clinical center
for FDNY responders in New York

The Clinical Center of Excellence
for FDNY Responders in New York specified in subsection (b)(1)(A) shall be
reimbursed—

(i)

in
the first year of the contract under this section, $600 per certified eligible
WTC responder in the medical treatment program, and $300 per certified eligible
WTC responder in the monitoring program; and

(ii)

in each
subsequent contract year, subject to paragraph (3), at the rates specified in
this subparagraph for the previous contract year adjusted by the WTC Program
Administrator to reflect the rate of medical care inflation during the previous
contract year.

(B)

Clinical centers
serving other eligible WTC responders in New York

A Clinical
Center of Excellence for other WTC responders in New York specified in
subsection (b)(1)(B) shall be reimbursed the amounts specified in subparagraph
(A).

(C)

Clinical centers
serving WTC community members

A Clinical Center of Excellence for
eligible WTC community members in New York specified in subsection (b)(1)(C)
shall be reimbursed—

(i)

in the first year of the contract under
this section, for each certified eligible WTC community member in a medical
treatment program enrolled at a non-hospital-based facility, $600, and for each
certified eligible WTC community member in a medical treatment program enrolled
at a hospital-based facility, $300; and

(ii)

in each subsequent contract year, subject
to paragraph (3), at the rates specified in this subparagraph for the previous
contract year adjusted by the WTC Program Administrator to reflect the rate of
medical care inflation during the previous contract year.

(D)

Other clinical
centers

A Clinical Center of Excellence or other providers not
described in a previous subparagraph shall be reimbursed at a rate set by the
WTC Program Administrator.

(E)

Reimbursement
rules

The reimbursement provided under subparagraphs (A), (B) and
(C) shall be made for each certified eligible WTC responder and for each WTC
community member in the WTC program per year that the member receives such
services, regardless of the volume or cost of services required.

(2)

Coordinating
Centers of Excellence

A Coordinating Centers of Excellence
specified in section (a)(2) shall be reimbursed for the provision of services
set forth in this section at such levels as are established by the WTC Program
Administrator.

(3)

Review of
rates

(A)

Initial
review

Before the end of the third contract year of the WTC
program, the WTC Program Administrator shall conduct a review to determine
whether the reimbursement rates set forth in this subsection provide fair and
appropriate reimbursement for such program services. Based on such review, the
Administrator may, by rule beginning with the fourth contract year, may modify
such rates, taking into account a reasonable and fair rate for the services
being provided.

(B)

Subsequent
reviews

After the fourth
contract year, the WTC Program Administrator shall conduct periodic reviews to
determine whether the reimbursement rates in effect under this subsection
provide fair and appropriate reimbursement for such program services. Based
upon such a review, the Administrator may by rule modify such rates, taking
into account a reasonable and fair rate for the services being provided.

(C)

GAO
review

The Comptroller General of the United States shall review
the WTC Program Administrator’s determinations regarding fair and appropriate
reimbursement for program services under this paragraph.

(d)

Requirements

The
WTC Program Administrator shall not enter into a contract with a Clinical
Center of Excellence under subsection (a)(1) unless—

(1)

the Center
establishes a formal mechanism for consulting with and receiving input from
representatives of eligible populations receiving monitoring and treatment
benefits under subtitle B from such Center;

(2)

the Center
provides for the coordination of monitoring and treatment benefits under
subtitle B with routine medical care provided for the treatment of conditions
other than WTC-related health conditions;

(3)

the Center
collects and reports to the corresponding Coordinating Center of Excellence
data in accordance with section 3005;

(4)

the Center has in place safeguards against
fraud that are satisfactory to the Administrator;

(5)

the Center agrees
to treat or refer for treatment all individuals who are eligible WTC responders
or eligible WTC community members with respect to such Center who present
themselves for treatment of a WTC-related health condition;

(6)

the Center has in
place safeguards to ensure the confidentiality of an individual’s individually
identifiable health information, including requiring that such information not
be disclosed to the individual’s employer without the authorization of the
individual;

(7)

the Center provides assurances that the
amounts paid under subsection (c)(1) are used only for costs incurred in
carrying out the activities described in subsection (a), other than those
described in subsection (a)(1)(A); and

(8)

the Center agrees
to meet all the other applicable requirements of this title, including
regulations implementing such requirements.

3007.

Entitlement
authorities

Subject to
subsections (b)(4)(C) and (c)(5) of section 3012, subtitle B constitutes budget
authority in advance of appropriations Acts and represents the obligation of
the Federal Government to provide for the payment for monitoring, initial
health evaluations, and treatment in accordance with such subtitle and section
3006(c) constitutes such budget authority and represents the obligation of the
Federal Government to provide for the payment described in such section.

3008.

Definitions

In this title:

(1)

The term aggravating means,
with respect to a health condition, a health condition that existed on
September 11, 2001, and that, as a result of exposure to airborne toxins, any
other hazard, or any other adverse condition resulting from the September 11,
2001, terrorist attacks on the World Trade Center requires medical treatment
that is (or will be) in addition to, more frequent than, or of longer duration
than the medical treatment that would have been required for such condition in
the absence of such exposure.

(2)

The terms certified eligible WTC
responder and certified eligible WTC community member mean
an individual who has been certified as an eligible WTC responder under section
3011(a)(4) or an eligible WTC community member under section 3021(a)(4),
respectively.

(3)

The terms
Clinical Center of Excellence and Coordinating Center of
Excellence have the meanings given such terms in section 3006(b).

(4)

The term
current consortium arrangements means the arrangements as in
effect on the date of the enactment of this title between the National
Institute for Occupational Safety and Health and the Mt. Sinai-coordinated
consortium and the Fire Department of the City of New York.

(5)

The terms
eligible WTC responder and eligible WTC community
member are defined in sections 3011(a) and 3021(a), respectively.

(6)

The term initial health
evaluation includes, with respect to an individual, a medical and
exposure history, a physical examination, and additional medical testing as
needed to evaluate whether the individual has a WTC-related health condition
and is eligible for treatment under the WTC program.

(7)

The term
list of identified WTC-related health conditions means—

(A)

for eligible WTC responders, the identified
WTC-related health condition for eligible WTC responders under section
3012(a)(3) or 3012(a)(4); or

(B)

for eligible WTC community members, the
identified WTC-related health condition for WTC community members under section
3022(b)(1) or 3022(b)(2).

(8)

The term
Mt.-Sinai-coordinated consortium means the consortium coordinated
by Mt. Sinai hospital in New York City that coordinates the monitoring and
treatment under the current consortium arrangements for eligible WTC responders
other than with respect to those covered under the arrangement with the Fire
Department of the City of New York.

(9)

The term New
York City disaster area means the area within New York City that
is—

(A)

the area of
Manhattan that is south of Houston Street; and

(B)

any block in
Brooklyn that is wholly or partially contained within a 1.5-mile radius of the
former World Trade Center site.

(10)

The term New York metropolitan
area means an area, specified by the WTC Program Administrator, within
which eligible WTC responders and eligible WTC community members who reside in
such area are reasonably able to access monitoring and treatment benefits and
initial health evaluation benefits under this title through a Clinical Centers
of Excellence described in subparagraphs (A), (B), or (C) of section
3006(b)(1).

(11)

Any reference to
September 11, 2001 shall be deemed a reference to the period on
such date subsequent to the terrorist attacks on the World Trade Center on such
date.

(12)

The term
September 11, 2001, terrorist attacks on the World Trade Center
means the terrorist attacks that occurred on September 11, 2001, in New York
City and includes the aftermath of such attacks.

(13)

The term
WTC Health Program Steering Committee means such a Steering
Committee established under section 3003.

(14)

The term
WTC Program Administrator means the individual responsible under
section 3001(f) for the administration of the WTC program.

(15)

The term
WTC-related health condition is defined in section 3012(a).

(16)

The term WTC
Scientific/Technical Advisory Committee means such Committee established
under section 3002.

For purposes of this title, the term eligible WTC
responder means any of the following individuals, subject to paragraph
(5):

(A)

Currently
identified responder

An individual who has been identified as
eligible for medical monitoring under the current consortium arrangements (as
defined in section 3008(4)).

(B)

Responder who
meets current eligibility criteria

An individual who meets the
current eligibility criteria described in paragraph (2).

(C)

Responder who
meets modified eligibility criteria

An individual who—

(i)

performed rescue,
recovery, demolition, debris cleanup, or other related services in the New York
City disaster area in response to the September 11, 2001, terrorist attacks on
the World Trade Center, regardless of whether such services were performed by a
State or Federal employee or member of the National Guard or otherwise;
and

(ii)

meets such
eligibility criteria relating to exposure to airborne toxins, other hazards, or
adverse conditions resulting from the September 11, 2001, terrorist attacks on
the World Trade Center as the WTC Program Administrator, after consultation
with the WTC Responders Steering Committee and the WTC Scientific/Technical
Advisory Committee, determines appropriate.

The WTC Program Administrator
shall not modify such eligibility criteria on or after the date that the number
of certifications for eligible responders has reached 80 percent of the limit
described in paragraph (5) or on or after the date that the number of
certifications for eligible community members has reached 80 percent of the
limit described in section 3021(a)(5).(2)

Current
eligibility criteria

The eligibility criteria described in this
paragraph for an individual is that the individual is described in either of
the following categories:

(A)

Fire fighters
and related personnel

The individual—

(i)

was a member of
the Fire Department of the City of New York (whether fire or emergency
personnel, active or retired) who participated at least one day in the rescue
and recovery effort at any of the former World Trade sites (including Ground
Zero, Staten Island land fill, and the NYC Chief Medical Examiner’s office) for
any time during the period beginning on September 11, 2001, and ending on July
31, 2002; or

(ii)(I)

is a surviving immediate family member of
an individual who was a member of the Fire Department of the City of New York
(whether fire or emergency personnel, active or retired) and was killed at the
World Trade site on September 11, 2001; and

(II)

received any treatment for a WTC-related
mental health condition described in section 3012(a)(1)(B) on or before
September 1, 2008.

(B)

Law enforcement
officers and wtc rescue, recovery, and clean-up workers

The
individual—

(i)

worked or
volunteered on-site in rescue, recovery, debris-cleanup or related support
services in lower Manhattan (south of Canal St.), the Staten Island Landfill,
or the barge loading piers, for at least 4 hours during the period beginning on
September 11, 2001, and ending on September 14, 2001, for at least 24 hours
during the period beginning on September 11, 2001, and ending on September 30,
2001, or for at least 80 hours during the period beginning on September 11,
2001, and ending on July 31, 2002;

(ii)(I)

was a member of the
Police Department of the City of New York (whether active or retired) or a
member of the Port Authority Police of the Port Authority of New York and New
Jersey (whether active or retired) who participated on-site in rescue,
recovery, debris clean-up, or related services in lower Manhattan (south of
Canal St.), including Ground Zero, the Staten Island Landfill or the barge
loading piers, for at least 4 hours during the period beginning September 11,
2001, and ending on September 14, 2001;

(II)

participated on-site in rescue,
recovery, debris clean-up, or related services in at Ground Zero, the Staten
Island Landfill or the barge loading piers, for at least one day during the
period beginning on September 11, 2001, and ending on July 31, 2002;

(III)

participated on-site in rescue,
recovery, debris clean-up, or related services in lower Manhattan (south of
Canal St.) for at least 24 hours during the period beginning on September 11,
2001, and ending on September 30, 2001; or

(IV)

participated on-site in rescue,
recovery, debris clean-up, or related services in lower Manhattan (south of
Canal St.) for at least 80 hours during the period beginning on September 11,
2001, and ending on July 31, 2002;

(iii)

was an employee of the Office of the Chief
Medical Examiner of the City of New York involved in the examination and
handling of human remains from the World Trade Center attacks, or other morgue
worker who performed similar post-September 11 functions for such Office staff,
during the period beginning on September 11, 2001 and ending on July 31,
2002;

(iv)

was a worker in
the Port Authority Trans-Hudson Corporation tunnel for at least 24 hours during
the period beginning on February 1, 2002, and ending on July 1, 2002; or

(v)

was a
vehicle-maintenance worker who was exposed to debris from the former World
Trade Center while retrieving, driving, cleaning, repairing, and maintaining
vehicles contaminated by airborne toxins from the September 11, 2001, terrorist
attacks on the World Trade Center during a duration and period described in
subparagraph (A).

(3)

Application
process

The WTC Program
Administrator in consultation with the Coordinating Centers of Excellence shall
establish a process for individuals, other than eligible WTC responders
described in paragraph (1)(A), to apply to be determined to be eligible WTC
responders. Under such process—

(A)

there shall be no
fee charged to the applicant for making an application for such
determination;

(B)

the Administrator
shall make a determination on such an application not later than 60 days after
the date of filing the application; and

(C)

an individual who
is determined not to be an eligible WTC responder shall have an opportunity to
appeal such determination before an administrative law judge in a manner
established under such process.

(4)

Certification

(A)

In
general

In the case of an
individual who is described in paragraph (1)(A) or who is determined under
paragraph (3) (consistent with paragraph (5)) to be an eligible WTC responder,
the WTC Program Administrator shall provide an appropriate certification of
such fact and of eligibility for monitoring and treatment benefits under this
part. The Administrator shall make determinations of eligibility relating to an
applicant’s compliance with this title, including the verification of
information submitted in support of the application, and shall not deny such a
certification to an individual unless the Administrator determines that—

(i)

based on the
application submitted, the individual does not meet the eligibility criteria;
or

(ii)

the numerical
limitation on eligible WTC responders set forth in paragraph (5) has been
met.

(B)

Timing

(i)

Currently
identified responders

In the case of an individual who is
described in paragraph (1)(A), the WTC Program Administrator shall provide the
certification under subparagraph (A) not later than 60 days after the date of
the enactment of this title.

(ii)

Other
responders

In the case of another individual who is determined
under paragraph (3) and consistent with paragraph (5) to be an eligible WTC
responder, the WTC Program Administrator shall provide the certification under
subparagraph (A) at the time of the determination.

(5)

Numerical
limitation on eligible WTC responders

(A)

In
general

The total number of
individuals not described in subparagraph (C) who may qualify as eligible WTC
responders for purposes of this title, and be certified as eligible WTC
responders under paragraph (4), shall not exceed 15,000, subject to adjustment
under paragraph (6), of which no more than 2,500 may be individuals certified
based on modified eligibility criteria established under paragraph (1)(C). In
applying the previous sentence, any individual who at any time so qualifies as
an eligible WTC responder shall be counted against such numerical
limitation.

(B)

Process

In
implementing subparagraph (A), the WTC Program Administrator shall—

(i)

limit the number
of certifications provided under paragraph (4) in accordance with such
subparagraph; and

(ii)

provide priority in such certifications in
the order in which individuals apply for a determination under paragraph
(3).

(C)

Currently
identified responders not counted

Individuals described in this
subparagraph are individuals who are described in paragraph (1)(A).

If the WTC Program Administrator determines
as of December 1, 2011, that the WTC expenditure-to-CBO-estimate percentage (as
defined in subparagraph (D)(iii)) for fiscal years 2009 through 2011 does not
exceed 90 percent, then, effective January 1, 2012, the WTC Program
Administrator may increase the numerical limitation under paragraph (5)(A), the
numerical limitation under section 3021(a)(5), or both, by a number of
percentage points not to exceed the number of percentage points specified in
subparagraph (C) for such period of fiscal years.

(B)

Subsequent
calculation for fiscal years 2009 through 2015

If the Secretary determines as of December
1, 2015, that the WTC expenditure-to-CBO-estimate percentages for fiscal years
2009 through 2015 and for fiscal years 2012 through 2015 do not exceed 90
percent, then, effective January 1, 2015, the WTC Program Administrator may
increase the numerical limitation under paragraph (5)(A), the numerical
limitation under section 3021(a)(5), or both, as in effect after the
application of subparagraph (A), by a number of percentage points not to exceed
twice the lesser of—

(i)

the number of
percentage points specified in subparagraph (C) for fiscal years 2009 through
2012, or

(ii)

the number of
percentage points specified in subparagraph (C) for fiscal years 2012 through
2015.

(C)

Maximum
percentage increase in numerical limitations for period of fiscal
years

The number of percentage points specified in this clause
for a period of fiscal years is—

(i)

100 percentage
points, multiplied by

(ii)

one minus a
fraction the numerator of which is the net Federal WTC spending for such
period, and the denominator of which is the CBO WTC spending estimate under
this title for such period.

(D)

Definitions

For
purposes of this paragraph:

(i)

Net Federal
spending

The term net Federal WTC spending means,
with respect to a period of fiscal years, the net Federal spending under this
title for such fiscal years.

(ii)

CBO WTC spending
estimate under this title

The term CBO WTC medical spending
estimate under this title means, with respect to—

(I)

fiscal years 2009
through 2011, $900,000,000;

(II)

fiscal years 2012
through 2015, $1,890,000,000; and

(III)

fiscal years
2009 through 2015, the sum of the amounts specified in subclauses (I) and
(II).

(iii)

WTC
expenditure-to-CBO-estimate percentage

The term WTC
expenditure-to-estimate percentage means, with respect to a period of
fiscal years, the ratio (expressed as a percentage) of—

(I)

the net Federal
WTC spending for such period, to

(II)

the CBO WTC
spending estimate under this title for such period.

(b)

Monitoring
Benefits

(1)

In
general

In the case of an
eligible WTC responder under section 3011(a)(4) (other than one described in
subsection (a)(2)(A)(ii)), the WTC program shall provide for monitoring
benefits that include medical monitoring consistent with protocols approved by
the WTC Program Administrator and including clinical examinations and long-term
health monitoring and analysis. In the case of an eligible WTC responder who is
an active member of the Fire Department of the City of New York, the responder
shall receive such benefits as part of the individual’s periodic company
medical exams.

(2)

Provision of
monitoring benefits

The
monitoring benefits under paragraph (1) shall be provided through the Clinical
Center of Excellence for the type of individual involved or, in the case of an
individual residing outside the New York metropolitan area, under an
arrangement under section 3031.

For purposes of this title, the term WTC-related
health condition means—

(A)

an illness or
health condition for which exposure to airborne toxins, any other hazard, or
any other adverse condition resulting from the September 11, 2001, terrorist
attacks on the World Trade Center, based on an examination by a medical
professional with experience in treating or diagnosing the medical conditions
included in the applicable list of identified WTC-related conditions, is
substantially likely to be a significant factor in aggravating, contributing
to, or causing the illness or health condition, as determined under paragraph
(2); or

(B)

a mental health condition for which such
attacks, based on an examination by a medical professional with experience in
treating or diagnosing the medical conditions included in the applicable list
of identified WTC-related conditions, is substantially likely be a significant
factor in aggravating, contributing to, or causing the condition, as determined
under paragraph (2).

In the
case of an eligible WTC responder described in section 3011(a)(2)(A)(ii), such
term only includes the mental health condition described in subparagraph
(B).(2)

Determination

The
determination of whether the September 11, 2001, terrorist attacks on the World
Trade Center were substantially likely to be a significant factor in
aggravating, contributing to, or causing an individual’s illness or health
condition shall be made based on an assessment of the following:

(A)

The individual’s
exposure to airborne toxins, any other hazard, or any other adverse condition
resulting from the terrorist attacks. Such exposure shall be—

(i)

evaluated and
characterized through the use of a standardized, population appropriate
questionnaire approved by the Director of the National Institute for
Occupational Safety and Health; and

(ii)

assessed and
documented by a medical professional with experience in treating or diagnosing
medical conditions included on the list of identified WTC-related
conditions.

(B)

The type of
symptoms and temporal sequence of symptoms. Such symptoms shall be—

(i)

assessed through the use of a standardized,
population appropriate medical questionnaire approved by Director of the
National Institute for Occupational Safety and Health and a medical
examination; and

(ii)

diagnosed and
documented by a medical professional described in subparagraph (A)(ii).

The WTC Program
Administrator may promulgate regulations to add an illness or health condition
not described in paragraph (3) to be added to the list of identified
WTC-related conditions for eligible WTC responders. In promulgating such
regulations, the Secretary shall provide for notice and opportunity for a
public hearing and at least 90 days of public comment. In promulgating such
regulations, the WTC Program Administrator shall take into account the findings
and recommendations of Clinical Centers of Excellence published in peer
reviewed journals in the determination of whether an additional illness or
health condition, such as cancer, should be added to the list of identified
WTC-related health conditions for eligible WTC responders.

(B)

Petitions

Any person (including the WTC Health
Program Scientific/Technical Advisory Committee) may petition the WTC Program
Administrator to propose regulations described in subparagraph (A). Unless
clearly frivolous, or initiated by such Committee, any such petition shall be
referred to such Committee for its recommendations. Following—

(i)

receipt of any
recommendation of the Committee; or

(ii)

180 days after the
date of the referral to the Committee,

whichever occurs first, the WTC
Program Administrator shall conduct a rulemaking proceeding on the matters
proposed in the petition or publish in the Federal Register a statement of
reasons for not conducting such proceeding.(C)

Effectiveness

Any
addition under subparagraph (A) of an illness or health condition shall apply
only with respect to applications for benefits under this title which are filed
after the effective date of such regulation.

(D)

Role of Advisory
Committee

Except with respect
to a regulation recommended by the WTC Health Program Scientific/Technical
Advisory Committee), the WTC Program Administrator may not propose a regulation
under this paragraph, unless the Administrator has first provided to the
Committee a copy of the proposed regulation, requested recommendations and
comments by the Committee, and afforded the Committee at least 90 days to make
such recommendations.

(b)

Coverage of
Treatment for WTC-Related Health Conditions

(1)

Determination
based on an identified WTC-related health condition for certified eligible WTC
responders

(A)

In
general

If a physician at a Clinical Center of Excellence that is
providing monitoring benefits under section 3011 for a certified eligible WTC
responder determines that the responder has an identified WTC-related health
condition, and the physician makes a clinical determination that exposure to
airborne toxins, other hazards, or adverse conditions resulting from the 9/11
terrorist attacks is substantially likely to be a significant factor in
aggravating, contributing to, or causing the condition—

(i)

the
physician shall promptly transmit such determination to the WTC Program
Administrator and provide the Administrator with the medical facts supporting
such determination; and

(ii)

on and after the date of such transmittal
and subject to subparagraph (B), the WTC program shall provide for payment
under subsection (c) for medically necessary treatment for such
condition.

(B)

Review;
certification; appeals

(i)

Review

A
Federal employee designated by the WTC Program Administrator shall review
determinations made under subparagraph (A) of a WTC-related health
condition.

(ii)

Certification

The
Administrator shall provide a certification of such condition based upon
reviews conducted under clause (i). Such a certification shall be provided
unless the Administrator determines that the responder’s condition is not an
identified WTC-related health condition or that exposure to airborne toxins,
other hazards, or adverse conditions resulting from the 9/11 terrorist attacks
is not substantially likely to be a significant factor in significantly
aggravating, contributing to, or causing the condition.

(iii)

Appeal
process

The Administrator shall provide a process for the appeal
of determinations under clause (ii) before an administrative law judge.

(2)

Determination
based on other wtc-related health condition

(A)

In
general

If a physician at a Clinical Center of Excellence
determines pursuant to subsection (a) that the certified eligible WTC responder
has a WTC-related health condition that is not an identified WTC-related health
condition for eligible WTC responders—

(i)

the physician
shall promptly transmit such determination to the WTC Program Administrator and
provide the Administrator with the facts supporting such determination;
and

(ii)

the Administrator
shall make a determination under subparagraph (B) with respect to such
physician’s determination.

(B)

Review;
certification

(i)

Use of physician
panel

With respect to each
determination relating to a WTC-related health condition transmitted under
subparagraph (A)(i), the WTC Program Administrator shall provide for the review
of the condition to be made by a physician panel with appropriate expertise
appointed by the WTC Program Administrator. Such a panel shall make
recommendations to the Administrator on the evidence supporting such
determination.

(ii)

Review of
recommendations of panel; certification

The Administrator, based
on such recommendations shall determine, within 60 days after the date of the
transmittal under subparagraph (A)(i), whether or not the condition is a
WTC-related health condition and, if it is, provide for a certification under
paragraph (1)(B)(ii) of coverage of such condition. The Administrator shall
provide a process for the appeal of determinations that the responder’s
condition is not a WTC-related health condition before an administrative law
judge.

(3)

Requirement of
medical necessity

(A)

In
general

In providing
treatment for a WTC-health condition, a physician shall provide treatment that
is medically necessary and in accordance with medical protocols established
under subsection (d).

(B)

Medically
necessary standard

For the purpose of this title, health care
services shall be treated as medically necessary for an individual if a
physician, exercising prudent clinical judgment, would consider the services to
be medically necessary for the individual for the purpose of evaluating,
diagnosing, or treating an illness, injury, disease or its symptoms, and that
are—

(i)

in
accordance with the generally accepted standards of medical practice;

(ii)

clinically
appropriate, in terms of type, frequency, extent, site, and duration, and
considered effective for the individual’s illness, injury, or disease;
and

(iii)

not primarily
for the convenience of the patient or physician, or another physician, and not
more costly than an alternative service or sequence of services at least as
likely to produce equivalent therapeutic or diagnostic results as to the
diagnosis or treatment of the individual’s illness, injury, or disease.

(C)

Determination of
medical necessity

(i)

Review of medical
necessity

As part of the
reimbursement payment process under subsection (c), the WTC Program
Administrator shall review claims for reimbursement for the provision of
medical treatment to determine if such treatment is medically necessary.

(ii)

Withholding of
payment for medically unnecessary treatment

The Administrator may
withhold such payment for treatment that the Administrator determines is not
medically necessary.

(iii)

Review of
determinations of medical necessity

The Administrator shall
provide a process for providers to appeal a determination under clause (ii)
that medical treatment is not medically necessary. Such appeals shall be
reviewed through the use of a physician panel with appropriate
expertise.

(4)

Scope of
treatment covered

(A)

In
general

The scope of
treatment covered under such paragraphs includes services of physicians and
other health care providers, diagnostic and laboratory tests, prescription
drugs, inpatient and outpatient hospital services, and other medically
necessary treatment.

(B)

Pharmaceutical
coverage

With respect to ensuring coverage of medically necessary
outpatient prescription drugs, such drugs shall be provided, under arrangements
made by the WTC Program Administrator, directly through participating Clinical
Centers of Excellence or through one or more outside vendors.

(C)

Transportation
expenses

To the extent provided in advance in appropriations
Acts, the WTC Program Administrator may provide for necessary and reasonable
transportation and expenses incident to the securing of medically necessary
treatment involving travel of more than 250 miles and for which payment is made
under this section in the same manner in which individuals may be furnished
necessary and reasonable transportation and expenses incident to services
involving travel of more than 250 miles under regulations implementing section
3629(c) of the Energy Employees Occupational Illness Compensation Program Act
of 2000 (title XXXVI of Public Law 106–398; 42 U.S.C. 7384t(c)).

(5)

Provision of
treatment pending certification

In the case of a certified eligible WTC
responder who has been determined by an examining physician under subsection
(b)(1) to have an identified WTC-related health condition, but for whom a
certification of the determination has not yet been made by the WTC Program
Administrator, medical treatment may be provided under this subsection, subject
to paragraph (6), until the Administrator makes a decision on such
certification. Medical treatment provided under this paragraph shall be
considered to be medical treatment for which payment may be made under
subsection (c).

Non-emergency
inpatient hospital services for a WTC-related health condition identified by an
examining physician under paragraph (b)(1) that is not certified under
paragraph (1)(B)(ii) is not covered unless the services have been determined to
be medically necessary and approved through a process established by the WTC
Program Administrator. Such process shall provide for a decision on a request
for such services within 15 days of the date of receipt of the request. The WTC
Administrator shall provide a process for the appeal of a decision that the
services are not medically necessary.

Subject to
subparagraph (B), the WTC Program Administrator shall reimburse costs for
medically necessary treatment under this title for WTC-related health
conditions according to the payment rates that would apply to the provision of
such treatment and services by the facility under the Federal Employees
Compensation Act.

(B)

Pharmaceuticals

(i)

In
general

The WTC Program Administrator shall establish a program
for paying for the medically necessary outpatient prescription pharmaceuticals
prescribed under this title for WTC-related conditions through one or more
contracts with outside vendors.

(ii)

Competitive
bidding

Under such program the Administrator shall—

(I)

select one or more
appropriate vendors through a Federal competitive bid process; and

(II)

select the lowest
bidder (or bidders) meeting the requirements for providing pharmaceutical
benefits for participants in the WTC program.

(iii)

Treatment of
FDNY participants

Under such program the Administrator may enter
select a separate vendor to provide pharmaceutical benefits to certified
eligible WTC responders for whom the Clinical Center of Excellence is described
in section 3006(b)(1)(A) if such an arrangement is deemed necessary and
beneficial to the program by the WTC Program Administrator.

(C)

Other
treatment

For treatment not covered under a preceding
subparagraph, the WTC Program Administrator shall designate a reimbursement
rate for each such service.

(2)

Medical
monitoring and initial health evaluation

The WTC Program
Administrator shall reimburse the costs of medical monitoring and the costs of
an initial health evaluation provided under this title at a rate set by the
Administrator.

(3)

Administrative
arrangement authority

The WTC Program Administrator may enter
into arrangements with other government agencies, insurance companies, or other
third-party administrators to provide for timely and accurate processing of
claims under this section.

(4)

Claims processing
subject to appropriations

The payment by the WTC Program
Administrator for the processing of claims under this title is limited to the
amounts provided in advance in appropriations Acts.

(d)

Medical
Treatment Protocols

(1)

Development

The Coordinating Centers of Excellence
shall develop medical treatment protocols for the treatment of certified
eligible WTC responders and certified eligible WTC community members for
identified WTC-related health conditions.

(2)

Approval

The
WTC Program Administrator shall approve the medical treatment protocols, in
consultation with the WTC Health Program Steering Committees.

2

Community
Program

3021.

Identification
and initial health evaluation of eligible WTC community members

(a)

Eligible WTC
community member defined

(1)

In
general

In this title, the term eligible WTC community
member means, subject to paragraphs (3) and (5), an individual who
claims symptoms of a WTC-related health condition and is described in any of
the following subparagraphs:

(A)

Currently
identified community member

An individual, including an eligible WTC
responder, who has been identified as eligible for medical treatment or
monitoring by the WTC Environmental Health Center as of the date of enactment
of this title.

(B)

Community member
who meets current eligibility criteria

An individual who is not an eligible WTC
responder and meets any of the current eligibility criteria described in a
subparagraph of paragraph (2).

(C)

Community member
who meets modified eligibility criteria

An individual who is not an eligible WTC
responder and meets such eligibility criteria relating to exposure to airborne
toxins, other hazards, or adverse conditions resulting from the September 11,
2001, terrorist attacks on the World Trade Center as the WTC Administrator
determines eligible, after consultation with the WTC Community Program Steering
Committee, Coordinating Centers of Excellence described in section
3006(b)(1)(C), and the WTC Scientific/Technical Advisory Committee.

The
Administrator shall not modify such criteria under subparagraph (C) on or after
the date that the number of certifications for eligible community members has
reached 80 percent of the limit described in paragraph (5) or on or after the
date that the number of certifications for eligible responders has reached 80
percent of the limit described in section 3021(a)(5).(2)

Current
eligibility criteria

The eligibility criteria described in this
paragraph for an individual are that the individual is described in any of the
following subparagraphs:

(A)

A person who was
present in the New York City disaster area in the dust or dust cloud on
September 11, 2001.

(B)

A person who
worked, resided or attended school, child care or adult day care in the New
York City disaster area for—

(i)

at
least four days during the 4-month period beginning on September 11, 2001, and
ending on January 10, 2002; or

(ii)

at least 30 days
during the period beginning on September 11, 2001, and ending on July 31,
2002.

(C)

Any person who
worked as a clean-up worker or performed maintenance work in the New York City
disaster area during the 4-month period described in subparagraph (B)(i) and
had extensive exposure to WTC dust as a result of such work.

(D)

A person who was
deemed eligible to receive a grant from the Lower Manhattan Development
Corporation Residential Grant Program, who possessed a lease for a residence or
purchased a residence in the New York City disaster area, and who resided in
such residence during the period beginning on September 11, 2001, and ending on
May 31, 2003.

(E)

A person whose
place of employment—

(i)

at
any time during the period beginning on September 11, 2001, and ending on May
31, 2003, was in the New York City disaster area; and

(ii)

was deemed
eligible to receive a grant from the Lower Manhattan Development Corporation
WTC Small Firms Attraction and Retention Act program or other government
incentive program designed to revitalize the Lower Manhattan economy after the
September 11, 2001, terrorist attacks on the World Trade Center.

(3)

Application
process

The WTC Program
Administrator in consultation with the Coordinating Centers of Excellence shall
establish a process for individuals, other than individuals described in
paragraph (1)(A), to be determined eligible WTC community member. Under such
process—

(A)

there shall be no
fee charged to the applicant for making an application for such
determination;

(B)

the Administrator shall make a
determination on such an application not later than 60 days after the date of
filing the application; and

(C)

an individual who is determined not to be
an eligible WTC community member shall have an opportunity to appeal such
determination before an administrative law judge in a manner established under
such process.

(4)

Certification

(A)

In
general

In the case of an
individual who is described in paragraph (1)(A) or who is determined under
paragraph (3) (consistent with paragraph (5)) to be an eligible WTC community
member, the WTC Program Administrator shall provide an appropriate
certification of such fact and of eligibility for followup monitoring and
treatment benefits under this part. The Administrator shall make determinations
of eligibility relating to an applicant’s compliance with this title, including
the verification of information submitted in support of the application and
shall not deny such a certification to an individual unless the Administrator
determines that—

(i)

based on the
application submitted, the individual does not meet the eligibility criteria;
or

(ii)

the numerical limitation on certification
of eligible WTC community members set forth in paragraph (5) has been
met.

(B)

Timing

(i)

Currently
identified community members

In the case of an individual who is
described in paragraph (1)(A), the WTC Program Administrator shall provide the
certification under subparagraph (A) not later than 60 days after the date of
the enactment of this title.

(ii)

Other
members

In the case of another individual who is determined under
paragraph (3) and consistent with paragraph (5) to be an eligible WTC community
member, the WTC Program Administrator shall provide the certification under
subparagraph (A) at the time of such determination.

(5)

Numerical
limitation on certification of eligible WTC community members

(A)

In
general

The total number of
individuals not described in subparagraph (C) who may be certified as eligible
WTC community members under paragraph (4) shall not exceed 15,000. In applying
the previous sentence, any individual who at any time so qualifies as an
eligible WTC community member shall be counted against such numerical
limitation.

(B)

Process

In
implementing subparagraph (A), the WTC Program Administrator shall—

(i)

limit the number
of certifications provided under paragraph (4) in accordance with such
subparagraph; and

(ii)

provide priority
in such certifications in the order in which individuals apply for a
determination under paragraph (4).

(C)

Individuals
currently receiving treatment not counted

Individuals described in this subparagraph
are individuals who—

(i)

are described in
paragraph (1)(A); or, before the date of the
enactment of this title, have received treatment for an identified WTC-related
condition for eligible WTC community members at the World Trade Center
Environmental Health Center at Bellevue Hospital Center, Gouverneur Health Care
Services, or Elmhurst Hospital Center

(ii)

before the date of the enactment of this
title, have received monitoring or treatment at the World Trade Center
Environmental Health Center at Bellevue Hospital Center, Gouverneur Health Care
Services, or Elmhurst Hospital Center.

The New
York City Health and Hospitals Corporation shall, not later than 6 months after
the date of enactment of this title, enter into arrangements with the Mt. Sinai
Data and Clinical Coordination Center for the reporting of medical data
concerning eligible WTC responders described in paragraph (1)(A), as determined
by the WTC Program Administrator and consistent with applicable Federal and
State laws and regulations relating to confidentiality of individually
identifiable health information.(D)

Report to
Congress if numerical limitation to be reached

If the WTC Program
Administrator determines that the number of individuals subject to the
numerical limitation of subparagraph (A) is likely to exceed such numerical
limitation, the Administrator shall submit to Congress a report on such
determination. Such report shall include an estimate of the number of such
individuals in excess of such numerical limitation and of the additional
expenditures that would result under this title if such numerical limitation
were removed.

In the case of a
certified eligible WTC community member, the WTC program shall provide for an
initial health evaluation to determine if the member has a WTC-related health
condition and is eligible for followup monitoring and treatment benefits under
the WTC program. Initial health evaluation protocols shall be approved by the
WTC Program Administrator, in consultation with the World Trade Center
Environmental Health Center at Bellevue Hospital and the WTC Community Program
Steering Committee.

(2)

Initial health
evaluation providers

The
initial health evaluation described in paragraph (1) shall be provided through
a Clinical Center of Excellence with respect to the individual involved.

(3)

Limitation on
initial health evaluation benefits

Benefits for initial health evaluation
under this part for an eligible WTC community member shall consist only of a
single medical initial health evaluation consistent with initial health
evaluation protocols described in paragraph (1). Nothing in this paragraph
shall be construed as preventing such an individual from seeking additional
medical initial health evaluations at the expense of the individual.

3022.

Followup
monitoring and treatment of certified eligible WTC community members for
WTC-related health conditions

(a)

In
general

Subject to subsection
(b), the provisions of sections 3011 and 3012 shall apply to followup
monitoring and treatment of WTC-related health conditions for certified
eligible WTC community members in the same manner as such provisions apply to
the monitoring and treatment of identified WTC-related health conditions for
certified eligible WTC responders, except that such monitoring shall only be
available to those certified as eligible for treatment under this title. Under
section 3006(a)(3), the City of New York is required to contribute a share of
the costs of such treatment.

(b)

List of
identified WTC-related health conditions for WTC community members

(1)

Identified
wtc-related health conditions for wtc community members

For purposes of this title, the term
identified WTC-related health conditions for WTC community members
means any of the following health conditions:

(A)

Aerodigestive
disorders

(i)

Interstitial lung
diseases.

(ii)

Chronic
respiratory disorder—fumes/vapors.

(iii)

Asthma.

(iv)

Reactive airways
dysfunction syndrome (RADS).

(v)

WTC-exacerbated
chronic obstructive pulmonary disease (COPD).

(vi)

Chronic cough
syndrome.

(vii)

Upper airway
hyperreactivity.

(viii)

Chronic
rhinosinusitis.

(ix)

Chronic
nasopharyngitis.

(x)

Chronic
laryngitis.

(xi)

Gastro-esophageal
reflux disorder (GERD).

(xii)

Sleep apnea
exacerbated by or related to a condition described in a previous clause.

Additions to
identified wtc-related health conditions for wtc community
members

The provisions of
paragraph (4) of section 3012(a) shall apply with respect to an addition to the
list of identified WTC-related conditions for eligible WTC community members
under paragraph (1) in the same manner as such provisions apply to an addition
to the list of identified WTC-related conditions for eligible WTC responders
under section 3012(a)(3).

3023.

Followup
monitoring and treatment of other individuals with WTC-related health
conditions

(a)

In
General

Subject to subsection
(c), the provisions of section 3022 shall apply to the followup monitoring and
treatment of WTC-related health conditions for eligible WTC community members
in the case of individuals described in subsection (b) in the same manner as
such provisions apply to the followup monitoring and treatment of WTC-related
health conditions for WTC community members. Under section 3006(a)(3), the City
of New York is required to contribute a share of the costs of such monitoring
and treatment.

(b)

Individuals
described

An individual described in this subsection is an
individual who, regardless of location of residence—

(1)

is not a eligible WTC responder or an
eligible WTC community member; and

(2)

is diagnosed at a Clinical Center of
Excellence (with respect to an eligible WTC community member) with an
identified WTC-related health condition for WTC community members.

(c)

Limitation

(1)

In
general

The WTC Program Administrator shall limit benefits for
any fiscal year under subsection (a) in a manner so that payments under this
section for such fiscal year do not exceed the amount specified in paragraph
(2) for such fiscal year.

(2)

Limitation

The
amount specified in this paragraph for—

(A)

fiscal year 2009
is $20,000,000; or

(B)

a succeeding fiscal year is the amount
specified in this paragraph for the previous fiscal year increased by the
annual percentage increase in the medical care component of the consumer price
index for all urban consumers.

3

National
Arrangement for Benefits for Eligible Individuals Outside New York

3031.

National
arrangement for benefits for eligible individuals outside New York

(a)

In
general

In order to ensure
reasonable access to benefits under this subtitle for individuals who are
eligible WTC responders or eligible WTC community members and who reside in any
State, as defined in section 2(f), outside the New York metropolitan area, the
WTC Program Administrator shall establish a nationwide network of health care
providers to provide monitoring and treatment benefits and initial health
evaluations near such individuals’ areas of residence in such States. Nothing
in this subsection shall be construed as preventing such individuals from being
provided such monitoring and treatment benefits or initial health evaluation
through any Clinical Center of Excellence.

(b)

Network
requirements

Any health care provider participating in the
network under subsection (a) shall—

(1)

meet criteria for
credentialing established by the Coordinating Centers of Excellence;

(2)

follow the
monitoring, initial health evaluation, and treatment protocols developed under
section 3006(a)(2)(B);

(3)

collect and report
data in accordance with section 3005; and

(4)

meet such fraud,
quality assurance, and other requirements as the WTC Program Administrator
establishes.

C

Research into
Conditions

3041.

Research
regarding certain health conditions related to September 11 terrorist attacks
in New York City

(a)

In
General

With respect to
individuals, including eligible WTC responders and eligible WTC community
members, receiving monitoring or treatment under subtitle B, the WTC Program
Administrator shall conduct or support—

(1)

research on
physical and mental health conditions that may be related to the September 11,
2001, terrorist attacks;

(2)

research on
diagnosing WTC-related health conditions of such individuals, in the case of
conditions for which there has been diagnostic uncertainty; and

(3)

research on
treating WTC-related health conditions of such individuals, in the case of
conditions for which there has been treatment uncertainty.

The
Administrator may provide such support through continuation and expansion of
research that was initiated before the date of the enactment of this title and
through the World Trade Center Health Registry (referred to in section 3051),
through a Clinical Center of Excellence, or through a Coordinating Center of
Excellence.(b)

Types of
research

The research under
subsection (a)(1) shall include epidemiologic and other research studies on
WTC-related conditions or emerging conditions—

(1)

among WTC
responders and community members under treatment; and

(2)

in sampled
populations outside the New York City disaster area in Manhattan as far north
as 14th Street and in Brooklyn, along with control populations, to identify
potential for long-term adverse health effects in less exposed
populations.

(c)

Consultation

The WTC Program Administrator shall carry
out this section in consultation with the WTC Health Program Steering
Committees and the WTC Scientific/Technical Advisory Committee.

(d)

Application of
Privacy and Human Subject Protections

The privacy and human
subject protections applicable to research conducted under this section shall
not be less than such protections applicable to research otherwise conducted by
the National Institutes of Health.

(e)

Authorization of
Appropriations

For the purpose of carrying out this section,
there are authorized to be appropriated $15,000,000 for each fiscal year, in
addition to any other authorizations of appropriations that are available for
such purpose.

D

Programs of the
New York City Department of Health and Mental Hygiene

3051.

World Trade
Center Health Registry

(a)

Program
Extension

For the purpose of ensuring on-going data collection
for victims of the September 11, 2001, terrorist attacks on the World Trade
Center, the WTC Program Administrator, shall extend and expand the arrangements
in effect as of January 1, 2008, with the New York City Department of Health
and Mental Hygiene that provide for the World Trade Center Health
Registry.

(b)

Authorization of
Appropriations

There are authorized to be appropriated $7,000,000
for each fiscal year to carry out this section.

3052.

Mental health
services

(a)

In
general

The WTC Program Administrator may make grants to the New
York City Department of Health and Mental Hygiene to provide mental health
services to address mental health needs relating to the September 11, 2001,
terrorist attacks on the World Trade Center.

(b)

Authorization of
appropriations

There are
authorized to be appropriated $8,500,000 for each fiscal year to carry out this
section.

.

II

September 11th
Victim Compensation Fund of 2001

201.

Definitions

Section 402 of the Air Transportation Safety
and System Stabilization Act (49 U.S.C. 40101 note) is amended—

(1)

in paragraph (6)
by inserting , or debris removal, including under the World Trade Center
Health Program established under section 3001 of the Public Health Service
Act, after September 11, 2001;

(2)

by inserting after
paragraph (6) the following new paragraphs and redesignating subsequent
paragraphs accordingly:

(7)

Contractor and
subcontractor

The term
contractor and subcontractor means any contractor or subcontractor
(at any tier of a subcontracting relationship), including any general
contractor, construction manager, prime contractor, consultant, or any parent,
subsidiary, associated or allied company, affiliated company, corporation,
firm, organization, or joint venture thereof that participated in debris
removal at any 9/11 crash site. Such term shall not include any entity,
including the Port Authority of New York and New Jersey, with a property
interest in the World Trade Center, on September 11, 2001, whether fee simple,
leasehold or easement, direct or indirect.

(8)

Debris
removal

The term debris
removal means rescue and recovery efforts, removal of debris, cleanup,
remediation, and response during the immediate aftermath of the
terrorist-related aircraft crashes of September 11, 2001, with respect to a
9/11 crash
site.

;

(3)

by inserting after
paragraph (10), as so redesignated, the following new paragraph and
redesignating the subsequent paragraphs accordingly:

(11)

Immediate
aftermath

The term
immediate aftermath means any period beginning with the
terrorist-related aircraft crashes of September 11, 2001, and ending on August
30, 2002.

the buildings or
portions of buildings that were destroyed as a result of the terrorist-related
aircraft crashes of September 11, 2001;

(C)

any area
contiguous to a site of such crashes that the Special Master determines was
sufficiently close to the site that there was a demonstrable risk of physical
harm resulting from the impact of the aircraft or any subsequent fire,
explosions, or building collapses (including the immediate area in which the
impact occurred, fire occurred, portions of buildings fell, or debris fell upon
and injured individuals); and

(D)

any area related to, or along, routes of
debris removal, such as barges and Fresh
Kills.

.

202.

Extended and
expanded eligibility for compensation

(a)

Information on
losses resulting from debris removal included in contents of claim
form

Section 405(a)(2)(B) of
the Air Transportation Safety and System Stabilization Act (49 U.S.C. 40101
note) is amended—

(1)

in clause (i), by
inserting , or debris removal during the immediate aftermath
after September 11, 2001;

(2)

in clause (ii), by
inserting or debris removal during the immediate aftermath after
crashes; and

(3)

in clause (iii),
by inserting or debris removal during the immediate aftermath
after crashes.

(b)

Extension of
deadline for claims under September 11th Victim Compensation Fund of
2001

Section 405(a)(3) of
such Act is amended to read as follows:

(3)

Limitation

(A)

In
general

Except as provided by
subparagraph (B), no claim may be filed under paragraph (1) after the date that
is 2 years after the date on which regulations are promulgated under section
407(a).

(B)

Exception

A claim may be filed under paragraph (1),
in accordance with subsection (c)(3)(A)(i), by an individual (or by a personal
representative on behalf of a deceased individual) during the period beginning
on the date on which the regulations are updated under section 407(b) and
ending on December 22,
2031.

.

(c)

Requirements for
filing claims during extended filing period

Section 405(c)(3) of
such Act is amended—

(1)

by
redesignating subparagraphs (A) and (B) as subparagraphs (B) and (C),
respectively; and

(2)

by inserting
before subparagraph (B), as so redesignated, the following new
subparagraph:

(A)

Requirements for
filing claims during extended filing period

(i)

Timing
requirements for filing claims

An individual (or a personal
representative on behalf of a deceased individual) may file a claim during the
period described in subsection (a)(3)(B) as follows:

(I)

In the case that
the Special Master determines the individual knew (or reasonably should have
known) before the date specified in clause (iii) that the individual suffered a
physical harm at a 9/11 crash site as a result of the terrorist-related
aircraft crashes of September 11, 2001, or as a result of debris removal, and
that the individual knew (or should have known) before such specified date that
the individual was eligible to file a claim under this title, the individual
may file a claim not later than the date that is 2 years after such specified
date.

(II)

In the case that
the Special Master determines the individual first knew (or reasonably should
have known) on or after the date specified in clause (iii) that the individual
suffered such a physical harm or that the individual first knew (or should have
known) on or after such specified date that the individual was eligible to file
a claim under this title, the individual may file a claim not later than the
last day of the 2-year period beginning on the date the Special Master
determines the individual first knew (or should have known) that the individual
both suffered from such harm and was eligible to file a claim under this
title.

(ii)

Other
eligibility requirements for filing claims

An individual may file
a claim during the period described in subsection (a)(3)(B) only if—

(I)

the individual was
treated by a medical professional for suffering from a physical harm described
in clause (i)(I) within a reasonable time from the date of discovering such
harm; and

(II)

the individual’s
physical harm is verified by contemporaneous medical records created by or at
the direction of the medical professional who provided the medical care.

(iii)

Date
specified

The date specified in this clause is the date on which
the regulations are updated under section
407(a).

.

(d)

Clarifying
applicability to all 9/11 crash sites

Section 405(c)(2)(A)(i) of
such Act is amended by striking or the site of the aircraft crash at
Shanksville, Pennsylvania and inserting the site of the aircraft
crash at Shanksville, Pennsylvania, or any other 9/11 crash
site.

(e)

Inclusion of
physical harm resulting from debris removal

Section 405(c) of such Act is amended in
paragraph (2)(A)(ii), by inserting or debris removal after
air crash.

(f)

Limitations on
civil actions

(1)

Application to
damages related to debris removal

Clause (i) of section
405(c)(3)(C) of such Act, as redesignated by subsection (c), is amended by
inserting , or for damages arising from or related to debris
removal after September 11, 2001.

(2)

Pending
actions

Clause (ii) of such section, as so redesignated, is
amended to read as follows:

(ii)

Pending
actions

In the case of an
individual who is a party to a civil action described in clause (i), such
individual may not submit a claim under this title—

(I)

during the period
described in subsection (a)(3)(A) unless such individual withdraws from such
action by the date that is 90 days after the date on which regulations are
promulgated under section 407(a); and

(II)

during the period
described in subsection (a)(3)(B) unless such individual withdraws from such
action by the date that is 90 days after the date on which the regulations are
updated under section
407(b).

.

(3)

Authority To
reinstitute certain lawsuits

Such section, as so redesignated, is
further amended by adding at the end the following new clause:

(iii)

Authority to
reinstitute certain lawsuits

In the case of a claimant who was a party
to a civil action described in clause (i), who withdrew from such action
pursuant to clause (ii), and who is subsequently determined to not be an
eligible individual for purposes of this subsection, such claimant may
reinstitute such action without prejudice during the 90-day period beginning
after the date of such ineligibility
determination.

.

203.

Requirement to
update regulations

Section 407
of the Air Transportation Safety and System Stabilization Act (49 U.S.C. 40101
note) is amended—

(1)

by striking
Not later than and inserting (a) In
general.—Not later than; and

(2)

by adding at the
end the following new subsection:

(b)

Updated
regulations

Not later than 90
days after the date of the enactment of the James Zadroga 9/11 Health and
Compensation Act of 2008, the Special Master shall update the regulations
promulgated under subsection (a) to the extent necessary to comply with the
provisions of title II of such
Act.

.

204.

Limited
liability for certain claims

Section 408(a) of the Air Transportation
Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended by adding
at the end the following new paragraphs:

(4)

Liability for
certain claims

(A)

In
general

Notwithstanding any other provision of law, subject to
subparagraph (B), liability for all claims and actions (including claims or
actions that have been previously resolved, that are currently pending, and
that may be filed through December 22, 2031) for compensatory damages,
contribution or indemnity, or any other form or type of relief, arising from or
related to debris removal, against the City of New York, any entity (including
the Port Authority of New York and New Jersey) with a property interest in the
World Trade Center on September 11, 2001 (whether fee simple, leasehold or
easement, or direct or indirect) and any contractors and subcontractors
thereof, shall not be in an amount that exceeds the sum of the
following:

(i)

The
amount of funds of the WTC Captive Insurance Company, including the cumulative
interest.

(ii)

The amount of all
available insurance identified in schedule 2 of the WTC Captive Insurance
Company insurance policy.

(iii)

The amount that
is the greater of the City of New York’s insurance coverage or $350,000,000. In
determining the amount of the City’s insurance coverage for purposes of the
previous sentence, any amount described in clauses (i) and (ii) shall not be
included.

(iv)

The amount of all
available liability insurance coverage maintained by any entity, including the
Port Authority of New York and New Jersey, with a property interest in the
World Trade Center, on September 11, 2001, whether fee simple, leasehold or
easement, or direct or indirect.

(v)

The amount of all available liability
insurance coverage maintained by contractors and subcontractors.

(B)

Exception

Subparagraph
(A) shall not apply to claims or actions based upon conduct held to be
intentionally tortious in nature or to acts of gross negligence or other such
acts to the extent to which punitive damages are awarded as a result of such
conduct or acts.

(5)

Priority of
claims payments

Payments to
plaintiffs who obtain a settlement or judgment with respect to a claim or
action to which paragraph (4)(A) applies, shall be paid solely from the
following funds in the following order:

(A)

The funds described
in clause (i) or (ii) of paragraph (4)(A).

(B)

If there are no
funds available as described in clause (i) or (ii) of paragraph (4)(A), the
funds described in clause (iii) of such paragraph.

(C)

If there are no funds available as
described in clause (i), (ii), or (iii) of paragraph (4)(A), the funds
described in clause (iv) of such paragraph.

(D)

If there are no funds available as
described in clause (i), (ii), (iii), or (iv) of paragraph (4)(A), the funds
described in clause (v) of such paragraph.

(6)

Declaratory
judgment actions and direct action

Any party to a claim or action to which
paragraph (4)(A) applies may, with respect to such claim or action, either file
an action for a declaratory judgment for insurance coverage or bring a direct
action against the insurance company
involved.

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